Does your dog take any medication, including flea/tick/heartworm preventative? *

How long have you had your dog? *

Where did you get your dog? *

Did your dog have other owners? *

Please list other pets in the household *

How many times a day does your dog go out? *

How many times a day does your dog eat? *

What exactly do you feed your dog? *

How large is your living space? (studio, house, 2 bedroom, etc) *

Who lives in the household? *

Has anything in the household changed since acquiring your dog? *

Describe how you leave from & return to your home (big hello & goodbye to the dog or no fuss) *

What does your dog do as you prepare to leave? *

What is your dog's training history, and at what age did you start? *

Please list what your dog knows (sit, leave it, etc) *

I grant my permission for Walk This Way Canine Behavior Therapy, LLC to train my dog to assist me as a service dog. I understand that all dogs and handlers must go through an evaluation regardless of whether or not they have worked with Walk This Way Canine Behavior Therapy, LLC in the past. I know that I must provide a letter from a physician stating what my medical condition is and why I would benefit from the aid of a service dog. If my dog is to assist my child, I understand that all children under the age of 18 must attend ALL sessions with a parent. I understand that any dog participating in this program must be non-aggressive to both humans and other dogs to be a service dog, and that fearful or shy/anxious dogs are not appropriate for this program. I agree to use ONLY positive training methods for all medical alert dog training. I am aware that I must present proof my dog has had all necessary vaccinations (Rabies, DHLP, Parvo) and is licensed. My dog must wear proper ID, a license and rabies tags at all times. My dog has attended a basic manners class and has a Canine Good Citizen Certification and I can provide proof of both. I agree to commit to weekly meetings as well as completion of daily training logs at home that will be sent to Walk This Way Canine Behavior Therapy, LLC via email between training sessions. Medical/family emergencies as well as vacations are viable excuses for a missed session, but if I must miss a session, I will still keep up the training at home and provide proof via the log. I expect to spend at least 8 weeks and possibly up to 16 weeks meeting with Walk This Way Canine Behavior Therapy, LLC weekly. In addition to this time, I will be given specific homework after each session and will be required to keep a detailed daily log of the work done at home. However, I understand that the duration of time spent training with Walk This Way Canine Behavior Therapy, LLC will vary depending on many factors – my dog’s drive, my ability to maintain training at home between sessions, my dog’s ability to stay focused in public around distraction, etc. I realize that it can take 6 months or longer to train a reliable alert dog. I understand that while Walk This Way Canine Behavior Therapy, LLC wishes to train my dog as efficiently as possible, the priority is to train him/her as thoroughly as needed. I understand that if I leave the program early, Walk This Way Canine Behavior Therapy, LLC will NOT provide me with the documentation necessary to register my dog as a service dog. I understand that medical alert training is an ongoing process, meaning I cannot merely attend training and expect the dog to stay sharp. I am committed to doing 20 minutes of training every day for the rest of my dog’s work life. I understand that dogs are not machines and that my service dog will not always be 100% reliable. Service dogs are to be used as tools but are not meant to replace all other tools (glucose meters, etc). Service dogs should be used in combination with all prescribed medical advice. Also, I realize that night alerts cannot be guaranteed as training a service dog to wake up from sleep to alert involves training the subconscious. I agree that Walk This Way Canine Behavior Therapy, LLC shall not be responsible for injuries to others (or their pets) who may be injured by my dog or by my acts, and I shall indemnify Walk This Way Canine Behavior Therapy, LLC their principals and their employees, for any and all costs, damages, claims or expenses (including reasonable attorneys' fees) that may result therefrom. I take full responsibility for any consequence to my animal and/or myself and/or any other animal and/or person. I hold Walk This Way Canine Behavior Therapy, LLC together with their principals, agents and employees, harmless for the actions of my dog. I do not hold Walk This Way Canine Behavior Therapy, LLC responsible for the actions of my animal during or after treatment. I understand that any photos of my dog that are obtained during training might be used for publicity purposes or teaching purposes by Walk This Way Canine Behavior Therapy, LLC. I ALSO UNDERSTAND THAT ALL DEPOSITS AND CLASS FEES ARE NON-REFUNDABLE. Cancellations made less than 48 hours in advance will incur a 50% fee. Cancellations made with less than 24 hours notice will incur the full fee. I certify that I am the owner of this animal and I am authorized to make decisions about this animal’s health and safety. By signing below I acknowledge that I have read and agree to the terms described above. By entering my name in the box below, I certify that this is a legal and binding signature. *